Management strategies of pediatric coccydynia: a narrative review

Pediatric coccydynia is a challenging, uncommon clinical entity that warrants management distinct from adult protocols, primarily due to the anatomical specificity of the developing coccyx. Despite its morbidity, current therapeutic decision-making is severely constrained by a critical lack of high-level evidence in the pediatric and adolescent population. This narrative review aims to address this knowledge gap by synthesizing the latest available literature on pediatric coccydynia to establish a contemporary, evidence-informed foundation for clinical practice. We performed a comprehensive search of in PubMed, Embase spanning from inception to the present, focusing on studies discussing the etiology, diagnosis, and management outcomes specifically in children and adolescents. The review structurally summarizes the distinguishing anatomy, diverse etiologies, and refined diagnostic approach relevant to pediatric coccydynia. The review outlines a potential stepwise treatment progression, beginning with non-operative strategies (including ergonomic adjustments, pharmacotherapy, and targeted nerve blocks) to coccygectomy as a reported surgical solution for refractory cases. This comprehensive synthesis offers a vital, evidence-informed framework for clinicians navigating the management of coccydynia in pediatric patients.